Dexcom G5 CGM System is now covered under Medicare
Scott Benner
From Dexcom.com - July 14, 2017
Important information regarding the recent Medicare announcement
Dexcom has begun to distribute Dexcom G5 CGM System supplies directly to eligible Medicare beneficiaries. We have contracted with Ascensia to provide the Contour® Next One blood glucose meter in the bundle of products covered by Medicare. Today, we are not licensed to service all 50 states, so we will also be using Medicare distributors to support us.
What does this ruling mean? Who is covered?
The ruling means Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy who meet the following criteria may now be able to obtain reimbursement:
- The beneficiary requires a therapeutic CGM. The beneficiary has diabetes mellitus; and,
- The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,
- The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
- The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
- Within six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
Note: With the initial Medicare coverage ruling, there is a requirement that patients only use the Dexcom G5 Receiver to view their glucose data and not a smart phone or other device. We realize that many patients want to use their smart phone to view their glucose data and we are continuing to work with CMS regarding this decision. For now, exclusive use of the G5 receiver is the requirement for Medicare reimbursement. Dexcom has no ability to override this decision, therefore, we must advise our customers not to use the app with the Medicare product. If a patient feels it is critical to have the ability to use the app, a non-Medicare reimbursed Dexcom system is available for purchase with a prescription.
The Medicare coverage decision for Dexcom G5 is a victory for patient access, and we hope, a first step in getting access to the entire Dexcom G5 set of capabilities. Beneficiaries should reach out to 1-800-MEDICARE with any questions about the Medicare requirements for Dexcom CGM.
Are other CGM products covered as well?
The ruling specifically states that only CGM products labeled as a replacement of fingerstick blood glucose testing for diabetes treatment decisions by the FDA and referred to in the ruling as “therapeutic CGM” will be covered. Thus, Dexcom G5 CGM System is the only therapeutic CGM on the market set to be covered by Medicare at this time.
How do I get my Dexcom G5 CGM System?
New patients should contact Dexcom by visiting Dexcom.com/medicare and submitting a Dexcom G5 CGM interest form. Priority will be given to existing Dexcom CGM patients followed by new patients in the order they were originally received. As our sales representatives work through the queue, patients can expect to hear from Dexcom or an authorized Dexcom distributor about getting started. This will be a slow process but we will ramp as quickly as we can.
Who will send me my Dexcom G5 CGM System?
We are happy to announce that Dexcom will begin to distribute Dexcom G5 CGM System supplies directly to eligible Medicare beneficiaries within the next few weeks. We have contracted with Ascensia to provide the Contour® Next One blood glucose meter in the bundle of products covered by Medicare. Today, we are not licensed to service all 50 states, so we will also be using Medicare distributors to support us.
How much can I expect to pay for my Dexcom G5 CGM System?
Patients who are covered by Medicare can expect to cover 20% of the costs, although this additional amount may be covered by secondary insurance. Medicare will cover the remaining 80%.
I am using a Dexcom G4 PLATINUM CGM. How will this affect me?
The ruling specifically states that only CGM products approved by the FDA as a replacement of fingerstick blood glucose testing for diabetes treatment decisions would be covered, so the Dexcom G4 PLATINUM will not apply. Currently, only the Dexcom G5 CGM System meets this criteria and would be eligible for Medicare coverage. Patients using Dexcom G4 PLATINUM may want to talk to their physicians or Dexcom to see if they would be eligible for Dexcom G5 CGM System.
I still have questions. Who can I contact?
Please call Dexcom Customer Service at 888-738-3646 for additional information.
